"The NHS will last as long as there are folk left with the faith to fight for it"Aneurin Bevan

Friday, 25 June 2010

Lansley's plans stalled... just

I warned about this before the election and yet no one in the Press seemed interested in the significance. More concerning, the Labour Party (and that pathetic excuse of a Health Secretary, Andy Burnham) who knew that the Tories were planning this, chose not to make it a central part of their election campaign. The break up and privatisation of the NHS has started by Andrew Lansley. This process has been stalled, but this is only temporary.

Let me give a little background (simplified, but just to give you the gist). Currently, the Department of Health (DoH) hands money to Primary Care Trusts (PCTs) to pay for the healthcare in the region. The PCT commissions services, which means that they decide how much healthcare will be required in the coming year, and then contracts providers to provide it. Usually this means NHS hospitals. When you need treatment your GP has to give you a choice of where you get that treatment and this choice is taken from providers that are commissioned to do the work. The treatment is paid by the PCT and each treatment is paid at the "national tariff" which is essentially the average cost of the treatment across the NHS in England.

From a hospital's point of view, they get paid per patient, the more patients they treat, the more money they get. If the hospital can perform the treatment for less than the national tariff they can keep the surplus. This surplus goes to provide new facilities or (frequently) to subsidise the treatments that they perform for more than the national tariff.

PCTs are public bodies and any member of the public can attend their meetings and ask questions. You can make them accountable for their commissioning decisions. Andrew Lansley intends to hand over all NHS commissioning to GPs. GPs are private businesses and there will be no democratic control over their governance. There will be no mechanism for you to challenge their commissioning decisions. There will be no way for you to choose to be treated in the hospital of your choice.

"The white paper got bounced back because there was no way the Treasury could sign up to a proposal which handed £80bn of public money to 35,000 GPs who are basically unaccountable private businesses," said one official.

This is a serious charge. But I would say that there is a far more important issue. GPs will be given powers to commission healthcare including services provided by themselves. Can you imagine the effect of this? Your GP will be handed a huge wad of money (£80bn given to 35,000 GPs means on average £2.3m each) and they will be allowed to spend some or all of that money on themselves. Do you really think they will send you to a specialist in a hospital when they think they could have a go themselves? The GP fundholding scheme (1991-1997) allowed some GPs to do this and the result was that fewer patients received specialist care at practices that had GP fundholding. Lansley wants to apply this over the entire NHS. You will not get the choice, if your GP has not commissioned your local hospital specialist to provide the service they will not be able to send you to the specialist.

The effect of this will be to reduce the number of patients seen by each NHS hospital, and this means that their income will reduce. This will result in a cut to the income of NHS hospitals. GPs, as businesses, will commission themselves to do the work which they think will be the most profitable. As I mentuioned above in your local hospital some treatements generate a surplus which subsidises other services. If GPs take the services that generate surpluses there will not be the subsidy. Those other services will suffer, and patients will suffer.

"Another issue is that to commission healthcare effectively, the new GP surgeries will need to oversee a large number of patients – with estimates of between 30,000 to 100,000."

In England each GP practice currently covers about 15,000 people. This means that the plans will involve the merging of two or even four practices. My town is 22,000 and there are two GP practices. I have the right to choose to register with one of two GP practices. Lansley's plan will mean that my town can only sustain one GP practice, and even then there may not be enough patients. It may mean that there will be one super GP practice covering my town and the neighbouring town. What has happened to the idea of a "family doctor"?

This is one of many truly terrible changes that Lansley plans for the NHS. The Treasury have blocked this temporarily, but the plan will return soon.